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Prescribing success

Managing a successful switch to over-the-counter status relies on recognition of key criteria, says Hugh Ferrier, managing director of Torre Lazur McCann, part of McCann Healthcare Worldwide

The dominance of doctors as prescribers for the past 150 years has limited the role of over-the-counter (OTC) medicines to palliative care and symptom relief. Now across Europe there is a need to control levels of reimbursement and target them where they are most needed and the pharma industry wants to extend the life cycle of drugs by broadening sector reach. Consequently, governments and industry are keen to widen the range of OTC medications that are available.

In the 1980s, there was a wave of switches in Italy, driven by reforms of the health system. One consequence is the success there of advanced ibuprofen-based analgesic brands. In Germany, low dose diclofenac-based analgesics, such as Voltaren 12.5mg, have been introduced OTC, and now stronger versions, such as Voltaren 25mg, are likely to be approved. Holland was the launch pad in Europe for the long-lasting pain proposition of Aleve (naproxen sodium). In 2001, it was announced in the UK that a broad range of prescription-only medicines (POMs) were to be switched to OTC, including statins and triptans.

Key success factors
An advertising agency is able to focus on the key communication questions in the switch to OTC:

  • Why are we advertising?
  • What are we selling?
  • To whom are we advertising?
  • What's in it for them (customer benefit)?
  • Why should they believe it?
  • What tools and channels can underpin brand credibility?

For POMs, we have the relative luxury of one-on-one selling by sales reps to the doctor in a 'push' market. For OTC, we are in an open, 'pull' market. We need to ensure we have a genuine brand to offer - a great product, distinct and relevant positioning, a competitive price, a clear communication proposition, a sufficient budget and the right channels to reach the key customers.

A communications grid is useful in clarifying the need for a different mix of message channels to achieve the objectives We should not assume that the launch into OTC is because the pharmaceutical division has eked out the last possible POM sale and the sector is now generic. We must ask more rigorous questions - ie, not just: 'is there a gap in the market?' but: 'is there a market in the gap?'

'There are pre-existing OTC products in most sectors and many are effective and well trusted. We need a real proposition for the OTC market. A well-signalled upcoming switch is Xenical (orlistat). Orlistat targets excess fat in the diet and its mode of action is essentially non-invasive. With the problem of obesity increasing in Europe, this product will be made available to a significant patient group.

What are we selling?
The POM to OTC switch in the early 1990s, of the H2-receptor anatagonists Pepcid, Tagamet and Zantac (developed for the management of ulcers), took longer than hoped for to achieve results. Cheap, effective, fast relief from OTC antacids, such as Rennies and Tums, was one obstacle, as was the fact that pharmacists were obliged to refer patients with persistent acute indigestion back to their doctors, meaning that H2s could not be promoted for prolonged use. Key questions pre-launch were:

  • Could an H2 antagonist match the speed of onset of a simple antacid?
  • Is it safe in use (perhaps with pharmacist counselling)? This is also a good time to ask if the product is bringing something new to the market. A good example is Novartis' Voltaren Emulgel. In 1999, it was not the first topical pain reliever but it had two, demonstrable benefits of superiority over existing OTC brands:
  • It was a more potent NSAID (diclofenac)
  • 'Emulgel' is a galenic formulation that sinks more deeply and rapidly through skin to the site of inflammation.

Another consideration is brand heritage. Consumers respond to a name they can trust. Most successful OTC switches transfer a name with a real, ethical heritage. Bayer's Canesten, Reckitt's Gaviscon, Novartis' Voltaren - all maintained prescription sales and leveraged the reputation of the ethical or semi-ethical brand name. If the risk of loss of reimbursement makes copying of the ethical brand name impossible, a variation of the name also works, such as Zantac 75 or Gaviscon 400.

Another route for a successful switch is to extend the consumer range of an existing OTC brand name, perhaps by introducing a variant with improved performance. This route appeals to pharma companies that don't want to get involved in OTC marketing. They can license out the ingredient to an OTC company. For example, a proton pump inhibitor (PPI) formulation could be licensed out to an existing indigestion brand, such as Rennies, to deliver the sales.

Taking an OTC to market
In ethical marketing, we have the luxury of the one-on-one sell. In OTC marketing, the principal tools are advertising - to build brand awareness, positioning and reputation. For long-term success, building credibility though recommendations from pharmacists is crucial. When Boots, switched its compound, ibuprofen, to OTC status in 1983, the ethical brand, Brufen, was still the anti-rheumatic of choice on prescription. Boots chose a new name - Nurofen - and armed it with: TV advertising (powered by a budget to match competitors such as Anadin); and the power of pharmacist recommendation. Boots pharmacies represented one in three high street OTC sales in the UK. With positive recommendations from almost one of third of people at the counter, the brand it built a distinct, positioning in headache and everyday acute pain (widening out from osteoarthritis). It gained massive credibility through this endorsement.

Advertising to whom?
In POM marketing, the marketer does not have to address in detail the end user. The message is communicated to the doctor who, in turn, finds the product users. The switch to OTC takes us into the world of the consumer and we need to construct a market map. An ideal, but expensive, quantitative research tool is the ad hoc usage and attitude (U&A) study (to assist in targeting and aid the media planner to plan a schedule). If funds won't allow a full U&A, we can often deploy ad hoc omnibus research to discern claimed category and brand usage levels. Alternatively, we can make use of audit data such as the BMRB Target Group Index (TGI) to give us profiling of our potential consumers, linked directly to their media consumption habits.

We also need qualitative research to give insights into consumer needs. The agency handling the switch of Voltaren Emulgel across Europe completed a study on attitudes to pain and pain relieving products in Germany, Italy, and the UK. It unearthed very different attitudes to the use of strong pain relievers in these three key markets. This research enables marketers to differentiate the brand and create a superior affinity for it through communications. The personality of the brand becomes as important as the performance differences in the product itself.

What's in it for them?
In consumer communication, is it essential to be single-minded and drive the brand through a positioning that offers a real benefit. Research has shown that an ethical brand is perceived as more effective, and more up-to-date technically, than existing OTCs. One of the most powerful launch statements an OTC brand can make, is: 'until recently, only available on prescription'. This quickly morphs into the top parity claims in headline or copy - 'you can't buy a more effective remedy without a prescription'.

The power of the pharmacist
The agency must recommend suitable materials, to bring the pharmacist and the counter staff on board. The brand must have proven top parity efficacy and the commercial margin should reward the pharmacist for their recommendation. A cosmeceutical brand, E45, launched by Boots in the 1930s as a dry skin cream, was promoted to doctors and practice nurses for the management of mild-to-moderate eczema, and then to pharmacists as an effective remedy for chronic dry skin problems. It remains the most recommended dry skin cream in UK pharmacies. This success has translated into market share with limited consumer advertising. Its precise semi-medical positioning has been copied by all the major brands.

The soft switch
Great commercial value is maintained in doctor and pharmacist endorsement, by creating what is often called the 'soft' switch. Not a complete switch out of POM and semi-ethical markets, but increasing consumer penetration by extension into the consumer market. The brand will rely heavily on the support of the pharmacist who will continue to dispense POM prescriptions. Pharmacists will still be key sales drivers, even after consumer advertising has been added to the mix.

Research shows that people with hayfever ask the pharmacist every season if any new remedies are available. This benefited the first non-sedating H1 receptors like Triludan, Seldane, Clarityn and Zirtek (still to be switched in the US), topical antihistamines such as Rhinolast, and the latest generation of corticosteroid anti-inflammatory agents in Beconase and Flixonase. Bayer's astute OTC marketing of the topical antifungal, Canesten, demonstrates the benefit of sustained pharmacy support. Over the years, the brand has invested in a wide range of in-pharmacy initiatives, including extensive training for staff, bringing a positive effect on the brand.

Executional considerations
Now we have a strategy for our switch and a product of unbeatable efficacy, possibly with some innovative features of format or presentation. It's packaged with a name that has ethical heritage and we plan to use the power of pharmacist recommendation to cement long-term credibility. A simple mnemonic for executing the communication idea is ROI. The acronym 'return on investment' can also prompt us to evaluate creative execution:

R - Is the idea Relevant?
O - Is the idea Ownable?
I - Is the idea Impactful?

  • Relevance matters: if the couple on a sunny beach does not communicate your great new anti-ageing sun cream, but rather that Barbados is a wonderful place for a holiday, then you have lost the relevance factor somewhere
  • Ownable matters: all communication is a potential investment, not a cost. The best ideas can be sustained over time, becoming a valued asset and a property for the brand. This commands true differentiation and customer preference
  • Impact matters: even the sector leaders in OTC brands are not big spenders in consumer advertising, compared with motor cars, banks, airlines, or alcoholic beverages. The brands we know dominate our advertising awareness through capturing their share of our minds. So a memorable proposition and image with impact that stands out will create and drive the awareness that a switch requires.

The future
The timing is right for new self-medication propositions. If a POM to OTC brand switch is a planned strategic move which incorporates the key criteria for success, it can bring benefits to all stakeholders, plus a commercial return for the investor.

3rd September 2007

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